Understanding the Factors that Drive Patients' Decision for Open versus Endoscopic Carpal Tunnel Release Surgery: A Conjoint Analysis Study
Bryan J. Pyfer, MD, MBA, Francesca Tocci, MA, Andrew Federer, MD, Suhail K. Mithani, MD.
Duke University Hospital, Durham, NC, USA.
PURPOSE: We sought to understand the most salient factors influencing patients' decision-making when choosing between open versus endoscopic carpal tunnel release by using patient-assigned utility scores in a conjoint analysis study. Current literature is replete with comparisons of outcomes between both techniques, but there is nothing published that explores patient preferences.
METHODS: The literature's best available studies were reviewed and provided us with patient-centered attributes of carpal tunnel syndrome management: duration of symptoms after surgery, time with loss of grip strength, time to return to work, rate of re-operation, and cosmetic result. Participants were recruited using Amazon Mechanical Turk and asked to assume they were experiencing carpal tunnel syndrome. They were presented with twelve discreet choice experiments using realistic variable values for each attribute as supported in the literature, and utility and importance scores were generated for each attribute using Sawtooth Discovery software.
RESULTS: Two-hundred seventeen respondents completed the experiments. The conjoint analysis revealed that the most influential factor on treatment choice was rate of re-operation (importance score of 32.8%), followed by cosmetic result (21.7%). Duration of symptoms was the least important attribute (13.5%). Sensitivity analysis revealed a reduction in re-operation rate of only 2.5% was more valuable to a respondent than a single endoscopic scar compared to two, three extra weeks away from work, four more weeks of pain, or ten more weeks of decreased grip strength.
CONCLUSION: Rate of re-operation, followed by aesthetic outcome, has greater impact on the decision for open versus endoscopic carpal tunnel release than does time with decreased grip strength, time away from work, or duration of symptoms.
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